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Distribution of Oxycodone in Postmortem Fluids and Tissues

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Distribution of Oxycodone in Postmortem Fluids and Tissues DOT/FAA/AM-10/11 Office of Aerospace Medicine Washington, DC 20591 Distribution of Oxycodone in Postmortem Fluids and Tissues Sabra R. Botch Robert D. Johnson Arvind K. Chaturvedi Russell J. Lewis Civil Aerospace Medical Institute Federal Aviation Administration Oklahoma City, OK 73125 June 2010 Final Report NOTICE This document is disseminated under the sponsorship of the U.S. Department of Transportation in the interest of information exchange. The United States Government assumes no liability for the contents thereof. ___________ This publication and all Office of Aerospace Medicine technical reports are available in full-text from the Civil Aerospace Medical Institute’s publications Web site: www.faa.gov/library/reports/medical/oamtechreports Technical Report Documentation Page 1. Report No. 2. Government Accession No. 3. Recipient's Catalog No. DOT/FAA/AM-10/11 4. Title and Subtitle 5. Report Date Distribution of Oxycodone in Postmortem Fluids and Tissues June 2010 6. Performing Organization Code 7. Author(s) 8. Performing Organization Report No. Botch SR, Johnson RD, Chaturvedi AK, Lewis RL 9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) FAA Civil Aerospace Medical Institute 11. Contract or Grant No. P.O. Box 25082 Oklahoma City, OK 73125 12. Sponsoring Agency Name and Address 13. Type of Report and Period Covered Office of Aerospace Medicine Federal Aviation Administration 800 Independence Ave., S.W. Washington, DC 20591 14. Sponsoring Agency Code 15. Supplemental Notes This work was accomplished under the approved task AM-B-10-TOX-204. 16. Abstract Introduction: Oxycodone is a heavily used and abused analgesic agent. Its pharmacological effects, including euphoria, respiratory depression, nausea, and drowsiness, have the potential to adversely affect performance. The postmortem distribution of oxycodone has not been well characterized, particularly at sub-lethal levels. Therefore, an attempt was made to evaluate the distribution of oxycodone in postmortem specimens collected from aviation accidents. Methods: A search of our database identified 4 oxycodone-positive fatalities from separate civil aviation accidents that occurred during a period of 6 years that had numerous biological tissues and fluids available (blood, urine, vitreous humor, liver, kidney, skeletal muscle, lung, spleen, heart muscle, and brain). These specimens were extracted using solid-phase extraction and were analyzed for oxycodone by GC/MS. Results: Oxycodone concentration ranges (µg/mL, µg/g) found in the different tissues and fluids were: blood 0.027-0.742, urine 2.20 - 12.5, vitreous humor 0.048 - 0.118, liver 0.103-3.35, lung 0.047-1.35, kidney 0.045- 3.12, spleen 0.115-2.43, muscle 0.017-0.400, brain 0.032-1.36, and heart 0.038-3.19. Conclusion: The blood concentrations found indicate that the oxycodone in these cases ranged from therapeutic to above therapeutic, but all were below lethal levels. Tissue/fluid to blood distribution coefficients were found to have large coefficients of variation (ranging from 26-128%), thereby rendering them unreliable for estimating a blood oxycodone concentration from a tissue value when no blood is available for analysis. 17. Key Words 18. Distribution Statement Forensic Toxicology, Oxycodone, Document is available to the public through the Distribution, GC/MS, Defense Technical Information Center, Ft. Belvoir, Aircraft Accident Investigation VA 22060; and the National Technical Information Service, Springfield, VA 22161 19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No. of Pages 22. Price Unclassified Unclassified 9 Form DOT F 1700.7 (8-72) Reproduction of completed page authorized i CONTENTs IntroductIon. 1 MaterIals.and.Methods . 1 . chemicals.and.reagents. 1 . Gas.chromatographic/Mass.spectroscopic.conditions. 1 . sample.selection.and.storage. 2 . calibrator.and.control.Preparation. 2 . sample.Preparation.and.extraction.Procedure . 2 results.and.dIscussIon. 3 references. 4 iii Distribution of oxycoDone in Postmortem fluiDs anD tissues INTrOduCTION MaTErIals aNd METhOds oxycodone,.a.semi-synthetic.opioid.agonist,.is.avail- Chemicals and reagents able.in.several.formulations,.including.controlled.release. all. aqueous. solutions. were. prepared. using. double. (oxycontin®),.immediate.release.(oxyIr®, Oxyfast®),. deionized.water.(ddW),.which.was.obtained.using.a. or.in.combination.with.other.non-narcotic.analgesics. water. purification. system. (elga. Water. systems;. high. such.as.acetaminophen.(Percocet®, Tylox®, Roxicet®). Wycombe, UK) ..all.chemicals.used.were.purchased.in. and.aspirin.(Percodan®) ..It.is.used.for.the.treatment.of. the.highest.possible.purity.and.used.without.any.fur- postoperative.pain,.pain.associated.with.cancer,.and. ther. purification .. oxycodone. and. oxycodone-d3. were. other.pain.management 1-3. Oxycodone.is.commonly. obtained. from. cerilliant. corporation. (round. rock,. employed.as.a.valuable.alternative.to.morphine.due.to. tX).as.methanolic.standards.at.concentrations.of.1 .00. its.longer.analgesic.action 4,5. Abuse.of.this.semi-synthetic. mg/ml.and.0 .100.mg/ml,.respectively,.in.sealed.glass. opiod.and.its.role.in.fatal.overdoses.has.been.documented. ampoules .. Propionic. anhydride. was. obtained. from. in.the.literature 6-11. .In.addition.to.the.analgesic.effects,. sigma-aldrich.(st ..louis,.Mo) ..the.ph.of.all.solutions. numerous.side.effects.have.been.associated.with.the.use. was.measured.using.a Corning Life Sciences.model.430. of.oxycodone ..dizziness,.drowsiness,.headache,.nausea,. ph.meter.(acton,.Ma),.connected.to.a Corning.3-in-1. vomiting,.and.muscle.weakness.have.been.linked.with. model.ph.electrode . the.use.of.this.drug .. oxycodone.is.readily.absorbed.after.oral.administra- Gas Chromatographic/Mass spectroscopic Conditions tion.and.has.pharmacokinetics.that.differs.from.that.of. analyses.were.performed.using.a.bench-top.gas.chro- morphine 5. The.volume.of.distribution.(Vd).of.oxyco- matograph/mass.spectrometer.(Gc/Ms),.which.consisted. done.is.277.±.187 L/kg.and.it.is.a.highly.protein-bound. of.a Hewlett.Packard.(hP).6890.series.Gc,.interfaced.with. drug.(45%) 4,12,13. The.large.Vd.for.oxycodone.suggests. a HP.5973.quadrupole.Ms.(agilent;.Palo Alto, CA) ..the. substantial.distribution.among.all.tissues.and.fluids.in. Gc/Ms.was.operated.with.a.transfer.line.temperature.of. the.body ..the.half-life.(t1/2).for.the.controlled-release. 280°c.and.a.source.temperature.of.250°c ..the.Ms.was. oral.formulation.of.oxycodone.has.been.documented. tuned.on.a.daily.basis.using.perfluorotributylamine ..the. to.range.from.approximately.3 .5.to.8.hours,1,4,5.and. electron.multiplier.voltage.was.set.at.106.eV.above.the. peak.therapeutic.plasma.concentrations.typically.oc- tune.value ..chromatographic.separation.was.achieved. cur.within.1.to.3.hours,.depending.on.inter-individual. using. a.Varian. factorfour. crosslinked. 100%. methyl. variation 14-16. The.duration.of.action.of.immediate.release. siloxane.capillary.column.12.m.x.0 .2.mm.i .d .,.0 .33.µm. oxycodone.is.~4.hours .5 Up.to.19%.of.ingested.oxyco- film.thickness.(Varian Co .; Harbor City,.ca .) ..helium. done.is.excreted.unchanged.after.oral.administration .1. was.employed.as.the.carrier.gas.at.a.flow.rate.of.1 .0.ml/ Within.24.hours,.30.to.60%.of.the.original.dose.has. min ..an HP.6890.autosampler.was.used.to.inject.1.µl. been.reported.to.be.excreted.in.the.urine.as.free.and/ of.extract.into.the.Gc/Ms ..the.Gc.was.equipped.with. or.conjugated.oxycodone,.conjugated.oxymorphone,. a.split/splitless.injection.port.operated.at.250°c.in.the. and.noroxycodone .14 splitless.mode.with.the.purge.time.of.0 .5.min ..the.oven. scientific.information.concerning.the.distribution.of. temperature.profile.employed.for.the.oxycodone.analysis. oxycodone.in.various.body.compartments.is.limited .7,9. was:.130°c.–.240°[email protected]°c/min,.240°c.–.244°c.@. Postmortem.samples.from.aviation.accident.victims.are. 2°c/min,.244°c.–.290°[email protected]°c/min,.with.a.final.hold. analyzed.for.drugs.at.the Federal Aviation Administra- time.of.1 35. .min ..Quantitation.and.qualifier.ions.for.each. tion’s. civil. aerospace. Medical. Institute. (caMI) .. a. analyte.were.then.selected.based.on.both.abundance.and. search.of.our.laboratory.accident.database.identified.four. mass-to-charge.ratio.(m/z) ..to.increase.reproducibility.and. aviation.fatalities.that.were.positive.for.oxycodone.in. reduce.interference,.high-mass.ions.were.selected.when. blood ..these.cases.also.had.a.full.complement.of.other. possible ..the.ions.chosen.for.oxycodone.were.371.(quant),. tissue.and.fluid.types.available.for.additional.analysis .. 314,.372,.and.for.oxycodone-d3.were.374.(quant),.317,. therefore,. this. study. was. pursued. to. determine. the. 375 ..upon.selection.of.unique.ions,.the.Ms.was.run.in. distribution.of.oxycodone.in.postmortem.tissues.and. selected.ion.monitoring.(sIM).mode.with.a.dwell.time. fluids.of.the.four.aviation.accident.victims .. of.30.msec.for.each.recorded.ion . 1 sample selection and storage sample Preparation and Extraction Procedure A search.of.the CAMI Toxflo™.database.(discoversoft. Postmortem.specimens,.calibrators,.and.controls.were. development,. llc;. oklahoma. city,. oK). identified. extracted.in.the.following.manner ..tissue.specimens.were. four. oxycodone-positive. fatalities. from. separate. civil. homogenized.in DDW.(1 .00% Naf).with.a.1:2.dilution. aviation. accidents. that. occurred.during. a. period. of. 6. tissue:DDW,.using.an Omni.post-mounted.homogenizer. years.(2003-2008) ..these.four.cases.had.a.majority.of.the. (Marietta,.Ga) ..the.generator.used.with.this.homogenizer. desired.biological.tissues.and.fluids.(blood,.urine,.vitreous. was.30.mm.in.diameter.and.set.to.rotate.at.22,000.rpm .. humor,.liver,.kidney,.skeletal.muscle,.lung,.spleen,.heart. three-ml.aliquots.of.fluid,.calibrator,.and.control,.and. muscle,.and.brain).were.used.for.the.study ..In.all.cases,. 3 .0.g.aliquots.of.each.tissue.homogenate.(1 .0.g.tissue). blood.was.stored.at.-20°c.in.tubes.containing.1 .00%. were.transferred.to.individual.16.x.150.mm.screw-top. (w/v).sodium.fluoride/potassium.oxalate.until.analysis .
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